Provider Demographics
NPI:1982360459
Name:FERNANDEZ, MONICA EILEEN (RN)
Entity Type:Individual
Prefix:
First Name:MONICA
Middle Name:EILEEN
Last Name:FERNANDEZ
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2023 E BERMUDA DUNES CT
Mailing Address - Street 2:
Mailing Address - City:ONTARIO
Mailing Address - State:CA
Mailing Address - Zip Code:91761-6411
Mailing Address - Country:US
Mailing Address - Phone:909-631-3513
Mailing Address - Fax:
Practice Address - Street 1:436 S RIVERSIDE AVE
Practice Address - Street 2:
Practice Address - City:RIALTO
Practice Address - State:CA
Practice Address - Zip Code:92376-6523
Practice Address - Country:US
Practice Address - Phone:909-877-8868
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-09
Last Update Date:2023-12-07
Deactivation Date:2023-11-02
Deactivation Code:
Reactivation Date:2023-12-07
Provider Licenses
StateLicense IDTaxonomies
CA95218552163W00000X
CA95027168363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse